Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(10), 1146–1153. https://doi.org/10.1002/clc.24092 Dr. Zirui Liu et al.
Points
- Cryoballoon ablation (CBA) is a potential first-line treatment for drug-refractory atrial fibrillation (AF) patients.
- A comprehensive analysis of randomized-controlled trials and an observational study showed that CBA is superior to antiarrhythmic drugs (AAD) for rhythm control in paroxysmal atrial fibrillation (PAF) patients.
- CBA demonstrated a significantly lower overall recurrence rate and better control of persistent AF than AAD.
- Patients undergoing CBA experienced improved quality of life (QoL) compared to those on AAD.
- CBA also resulted in a lower hospitalization rate at the 36-month follow-up than AAD.
Summary
This research paper aimed to compare the efficacy of cryoballoon ablation (CBA) as a first-line treatment versus antiarrhythmic drugs (AAD) for rhythm control in patients with drug-refractory atrial fibrillation (AF). The study comprehensively searched multiple databases to identify relevant randomized-controlled trials and an observational study. The primary outcomes of interest included overall recurrence rate, incidence of persistent AF, quality of life (QoL), and hospitalization rate. The pooled analysis of the included studies revealed significant advantages of CBA over AAD regarding these outcomes.
A systematic search was conducted in PubMed, Embase, Cochrane, and Web of Science databases. Five randomized-controlled trials involving 923 patients and an observational study were included in the analysis. The treatment efficacy was assessed using risk ratio (RR) and standardized mean difference (SMD) with a 95% confidence interval (CI). The primary outcomes were analyzed using these statistical measures, and heterogeneity was assessed using I2 statistics.
The analysis showed that the CBA group had a significantly lower overall recurrence rate than the AAD group (RR = 0.59, 95% CI = 0.49–0.71, p < .05, I2 = 0). Additionally, the incidence of persistent AF was better controlled in the CBA group compared to the AAD group (RR = 0.17, 95% CI = 0.06–0.49, p < .05, I2 = 0). Furthermore, CBA was found to improve the quality of life (QoL) of patients more effectively than AAD (SMD = 0.40, 95% CI = 0.14–0.67, p < .05, I2 = 68.5%). Moreover, CBA significantly reduced the hospitalization rate compared to AAD at the 36-month follow-up (RR = 0.29, 95% CI = 0.15-0.58, p < .05, I2 = 0%).
In patients with drug-refractory atrial fibrillation, cryoballoon ablation (CBA) as a first-line therapy demonstrated superior outcomes compared to antiarrhythmic drugs (AAD). CBA resulted in a lower overall recurrence rate, better control of persistent AF, improved quality of life, and reduced hospitalization rates. These findings suggest that CBA should be considered an effective treatment option for rhythm control in patients with paroxysmal atrial fibrillation (PAF). Further research is warranted to validate these results and explore long-term outcomes.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24092
References Liu, Z., Yang, Z., Lu, Y., Wang, H., & Zou, C. (2023). Short-term and long-term effects of cryoballoon ablation versus antiarrhythmic drug therapy as first-line treatment for paroxysmal atrial fibrillation: A systematic review and meta-analysis. Clinical Cardiology, 46(10), 1146–1153. https://doi.org/10.1002/clc.24092
